In general terms the "bowel" extends from the stomach to the anus and comprises the small intestine and the large intestine. The small intestine comprises three main sections, the duodenum (which is adjacent to the stomach), the jejunum (which is intermediate) and the ileum (which is distant to the stomach). The large intestine (which is termed the colon) is joined to the remote end of the ileum of the small intestine by the ileocecal valve. The large intestine (colon) comprises two main sections, the caecum (which is connected to the ileum of the small intestine), and the rectum, which is the remote part of the large intestine (colon). The remote end of the rectum is connected to the anus.
The term "inflammatory bowel disease" (IBD) is a generic expression which encompasses a number of specific bowel diseases including ulcerative colitis, chronic proctitis and Crohn's disease. These diseases may or may not overlap with one another to a certain extent. When they do, they blur the boundaries between the various types of IBD afflictions. Ulcerative colitis is a chronic, non-specific inflammatory bowel disease which involves ulcerative lesions of the colon. Chronic proctitis comprises inflammation of the colon and often the rectum. Crohn's disease appears as several types of intestinal inflammation but most often the term refers to inflammation of the terminal portion of the ileum. Synonyms of Crohn's disease are regional enteritis (the intestine) or regional iletis, although the latter is not always apt since Crohn's disease is not limited to the ileum. Crohn's disease often involves diseases, fistulas (deep sinnous passages or tracts in the colon), perianal ulcerations and narrowing of the intestinal lumen (strictures). Surgical removal of the diseased portion of the intestine (termed a colectomy, or ileectomy) is reserved for those cases which are most resistant to treatment, since about half of those treated by surgery experience a recurrence of the disease in another segment of the intestine. The most common clinical symptoms of Crohn's disease include abdominal pain, fever, anorexia, weight loss and a right lower quadrant "fullness".
Inflammatory bowel disease (IBD) can involve inflammatory disruption of vascular and matrix glycosaminoglycans (GAGs), specifically the loss of GAG's from the intestinal wall which results in fibrosis of the bowel and a loss of function (see S. H. Murch, et al., Reference 3 in Bibliography). Organ culture shows this disruption is due to the presence of matrix degrading enzymes (see S. L. Pender, et al., Reference 6 in Bibliography).
Statistics indicate that approximately 1 percent of the North American population suffer from inflammatory bowel disease (IBD) of one form or another. The annual incidence of ulcerative colitis (UC) is estimated at between six to eight cases per 100,000 population per year, with the onset of the disease occurring most frequently between the ages of 30 and 50. Since its recognition several decades ago, Crohn's Disease has increased in incidence and it is estimated to affect between twenty and seventy persons per year per 100,000 population, with 15,000 to 30,000 new cases occurring each year in the United States. By age 85, it is estimated that nearly two-thirds of the population have developed some diverticula in their colon.
A recent survey in France found an incidence of 4.9 per 100,000 for Crohn's Disease and 3.2 for ulcerative colitis. The highest age specific incidence for Crohn's Disease was 20 to 29 years, whereas for ulcerative colitis, it was between 20 and 39 years. The incidence of Crohn's Disease in France was similar to northern European studies, but the incidence of ulcerative colitis was lower.
Historically, inflammatory bowel disease (IBD) has conventionally been treated by the use of steroidal anti-inflammatory drugs such as cortisone or sulphasalazine, or antispasmodic agents such as propantheline and dicyclomine, supplemented with laxative or anti-diarrheal drugs, as well as drugs which reduce intestinal motility, depending on symptoms. More recently, 5-aminosalicylic acid (5-ASA) and related drugs, which are considered the active moiety of sulphasalazine, have been found to be effective in the treatment of inflammatory bowel disease. Their action may be related to an ability to remove irritating superoxide radicals formed in inflamed tissues. In severe, refractory disease the use of immunosuppressant drugs, such as azathioprine, may be used. In many cases, surgery to remove severely damaged intestinal tissue is required.
______________________________________ Issue Date Inventor ______________________________________ U.S. Pat. No. 5,229,374 January 1992 Burton and Freeman 5,192,750 March 1993 Burton and Gislason 5,217,962 June 1993 Burton and McLean Canadian granted Burton Patent No. June 1, 1993, 1,318,592 ______________________________________